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Biomedical subjects

K Ivancev

Publications and source records attributed to K Ivancev.

At least 91 records · Page 5Linked to original sources

Percutaneous gastrostomy. A clinical and experimental study.

Fluoroscopic percutaneous gastrostomy for the purpose of nutrition was performed in 28 patients with the aid of a specially designed gastrostomy set. No major complications were reported. Exchange to Foley catheter was performed after 7 days and could be used without complications for the patients' remaining life span. In order to evaluate the formation of a gastrocutaneous tract, an experimental study with the same instruments as in clinical practice was performed in 13 rabbits. Within one week a gastrocutaneous tract was formed, which was possible to dilate for insertion of a balloon catheter of larger size. The described procedure is a simple and time-saving method for a percutaneous gastrostomy in debilitated patients with dysphagia.

Aged↗

Thrombogenicity of metallic vascular stents in arteries and veins--an experimental study in pigs.

Endovascular expanding metallic stents were percutaneously implanted in the iliac arteries and veins of pigs. The vessels had been stenosed by a ligature of catgut 4 weeks prior to this. Platelets were labeled with Indium 111 and the deposition onto the dilated and stented areas was dynamically registered for 240 min with a scintillation camera. All six arterial and six venous stents remained patent throughout the examination period. At the site of arterial stenting there was an increase, of deposited activity, and in the veins a decrease. These experimental findings support the use of endovascular stents after dilation, especially in venous stenoses.

Angioplasty, Balloon↗

Effect of subclavian flap angioplasty on growth and circulation of the left front leg in pigs.

The effect of subclavian flap angioplasty on the growth of the left front limb and on its collateral circulation was studied in 11 pigs. The left subclavian artery and its first branch, the costocervical trunk, were divided while the remaining three branches--the deep cervical, the vertebral and the internal thoracic artery--were preserved. Postoperative angiographies (5 pigs) showed that the blood supply to the left front limb was maintained through these three branches, which acted as collaterals, supplying blood in retrograde fashion. The left vertebral artery was seen to be the predominant collateral already on postoperative day 1. Four months later the diameter of the left vertebral artery had increased more than that of the contralateral (right) vertebral artery. Eight months postoperatively the size of both front legs (6 pigs) was the same. No signs of cerebral disturbance were seen. The clinical implications of the findings are discussed.

Animals↗

Ultrasonography and Doppler Duplex compared with angiography in follow-up of mesocaval shunt patency.

Thirty-four patients with portal hypertension of various etiologies were operated upon with an interposition mesocaval Goretex graft. During a period of 6 years 84 angiographic and ultrasonographic (US) examinations (53 B-mode, and 31 Doppler Duplex) were performed, with few exceptions within 3 days. Angiography served as the 'gold standard'. Shunt patency was correctly interpreted as normal in B-mode US in 38 examinations. Shunt occlusion, definite or probable, was seen in 12 B-mode examinations, where angiography demonstrated occlusion in 6 and patency in the remaining 6 shunts. Shunt occlusion was not observed sonographically in one examination. US was technically inadequate on two occasions. Doppler Duplex showed shunt patency in all 31 examinations, which was correct according to angiography. Both B-mode US, in 6 out of 6 examinations, and Doppler Duplex, in 7 out of 9 examinations failed to reveal shunt stenosis. Five patients with abundant venous collaterals (in one case with aberrant vascular anatomy) were not possible to evaluate even after the introduction of Doppler Duplex, which otherwise facilitated the evaluation. We suggest that US including Doppler should be the primary modality for follow-up in patients with interposition mesocaval Goretex grafts.

Adolescent↗

Mediastinal pseudomass: pneumonia and atelectasis behind the left pulmonary ligament.

In children, left lower lobe pneumonia posterior to the pulmonary ligament may mimic a paramediastinal mass. Over a period of 6 years we have seen 12 children with this unusual appearance, which we attribute to a peculiar type of atelectasis or infiltration of the left lower lobe or a segment of it. The radiographic appearance is thought to be the result of incomplete anchoring of the left lung by a short pulmonary ligament. The radiographic findings are demonstrated, and the benign clinical course is emphasized.

Child↗

Transluminal balloon dilation of ureteral stricture in a child. A case report.

A 12-year-old girl complained of left flank pain 4 months after the onset of symptoms of polyarthritis nodosa with hypertension, multiple neuritis and impaired renal function. Intravenous pyelography (IVP) revealed no stone. Several months later the flank pain recurred, and IVP now showed a calcified stone midway in the left ureter. Ureterolithotomy was performed, and a 3 cm long stone embedded in the mucosa was removed. Two months postoperatively IVP showed severe ureteric obstruction due to stenosis at the level of the incision. Dilation of the stricture was accomplished with a 4 mm balloon, and further dilation 2 weeks later with a 6 mm balloon. A third dilation was performed with a 4 mm balloon. At examination 3 months later the girl was free from symptoms and IVP with forced diuresis was normal, as were the findings after 6 more months. Transluminal balloon dilation of postoperative ureteral strictures in children should be considered as an alternative to surgery.

Child↗

Malrotation in children with symptoms of gastrointestinal allergy and psychosomatic abdominal pain.

Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritable and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.

Abdomen↗

A simplified method for total arterialization of the liver in rats.

Total arterialization of the liver appears to be a promising clinical method in preventing or reducing encephalopathy after shunting. A new technique for achieving total arterialization of the liver in rats in described and illustrated. This method is fast, simple, and associated with a high patency rate, even in the hands of relatively inexperienced microsurgeons. It can be recommended as an experimental model for additional studies in rats.

Animals↗

Value of computed tomography in traumatic pancreatitis in children.

Only a few previous reports have stressed the value of computed tomography (CT) in traumatic pancreatitis in children. Three children with blunt upper abdominal trauma are presented, two of them had operatively confirmed pancreatic injury while in the third the clinical course confirmed the early exclusion of such injury at CT examination. A meteoristic abdomen, as is frequently present in acutely injured children, limited the early usefulness of ultrasound (US) in one of the patients. In all 3 patients, CT examination yielded important information. US proved easy to perform and reliable in the follow-up of complications such as pseudocysts.

Child↗

Aneurysms of the pancreaticoduodenal artery associated with occlusion of the celiac artery.

Aneurysms of the pancreaticoduodenal artery are rare and may be associated with celiac artery stenosis or occlusion. Twenty-eight patients are reported in the literature. The diagnostic findings and therapeutic alternatives of four additional patients form the basis of this report. One patient with ruptured pancreaticoduodenal aneurysm was successfully treated by transcatheter embolization, and one patient was treated surgically; both patients had an uneventful recovery. In the remaining two patients, the aneurysms were left untreated. One patient died 1 year later of an unrelated cause, and the other patient is symptom-free after 2 years.

Aged↗

Interventional treatment of hepatic arterial and venous pathology: a commentary.

Hepatic aneurysms, pseudoaneurysms and fistulas (arterial biliary and arterial portal) causing bleeding or portal hypertension, and arteriovenous malformations causing high output cardiac failure in adults can be successfully managed by embolization techniques. Results of embolization in infantile hemangioendotheliomas are less uniform and tumors with massive arteriovenous shunting are difficult to manage. Transjugular intrahepatic portal systemic shunts using expendable stents have been successfully created in patients and have effectively controlled portal hypertension and variceal bleeding.

Aneurysm↗

Percutaneous hepaticoneojejunostomy and choledochocholedochal reanastomosis using metallic stents: technical note.

A new, nonsurgical approach to biliary duct reconstruction in two high-operative risk patients is presented. The first patient with an obstructed hepaticojejunostomy underwent such reconstruction by placement of Wallstent, which remained patent 9 months until death from recurrent tumor. The second patient with an inadvertently ligated common bile duct underwent a combined percutaneous transhepatic-retrograde endoscopic reconstruction with placement of a Gianturco-Rösch (GR) stent. Because of occlusion by granulation tissue 5 months later, a new GR stent covered with a silicone membrane was placed within the initial stent. Nine months after the second GR stent placement there is no evidence of obstruction.

Adult↗

Gianturco-Rösch expandable Z-stents in the treatment of superior vena cava syndrome.

Gianturco-Rösch expandable Z-stents were used in 22 patients with superior vena cava syndrome (SVCS). Stents were placed in all patients in the SVC and in 17 patients, also into the innominate veins. Stent placement resulted in complete relief of symptoms in all patients. Twenty-one patients had no SVCS recurrence from 1 to 16 months, to their death, or to the present time. SVCS recurred only in 1 patient 9 months after stent placement due to tumor ingrowth and secondary thrombosis. Based on ours and on other reported experiences, expandable metallic stents are effective devices for treatment of the SVCS which is difficult to manage by other means.

Brachiocephalic Veins↗